纤维支气管镜下支气管肺泡灌洗治疗儿童重症支原体肺炎的效果观察

纤维支气管镜下支气管肺泡灌洗治疗儿童重症支原体肺炎的效果观

察

目的探討纤维支气管镜下支气管肺泡灌洗治疗儿童重症支原体肺炎的应用价值。方法选取我院2015年1月～2016年12月住院儿童经X线胸片、CT及实验室指标证实为重症支原体肺炎100例作为研究对象，且经纤维支气管镜除外异物、畸形、肿瘤、结核等，明确为感染所致。根据治疗方法不同分为两组，观察组和常规组各50例。常规组用呼吸机辅助呼吸、抗感染、营养支持及对症治疗，观察组行床旁纤维支气管镜吸痰、灌洗、注药治疗。观察两组的疗效、安全性。结果观察组治疗有效率为96.0%，对照组治疗有效率为76.0%，差异有统计学意义（P＜0.05）；在咳嗽、胸疼、肺部啰音、肺部X线吸收时间比较，观察组较对照组明显缩短，差异有统计学意义（P＜0.01）；观察组发生并发症2例，并发症发生率为4.0%，鼻出血及术后发热各1例，给予对症治疗后明显改善、好转。对照组无并发症发生，两组并发症发生率比较差异无统计学意义（P>0.05）。结论纤维支气管镜下支气管肺泡灌洗对小儿重症支原体肺炎有明显的治疗作用，且安全、有效。

[Abstract]Objective To explore the application value of bronchoalveolar lavage in the treatment of severe Mycoplasma pneumonia in children under fiber bronchoscope.Methods A total of 100 pediatric patients who were diagnosed with severe Mycoplasmal pneumonia by X-ray，CT and laboratory indicators in our hospital from January 2015 to December 2016 were selected as research objects.The etiology was exclusively due to inflammation by fiber bronchoscope ruling out of foreign substance，deformity，tumor，and nodule.According to different therapeutic methods，they were divided into two groups.Regular applications of ventilator-assisted respiration，anti-infection，nutritional support，and symptomatic treatment were provided in both groups.In observation group（n=50），bedside sputum suction by fiber bronchoscope，lavage，and drug injection were provided，while in control group（n=50），sputum suction tube and humidifying for treatment were adopted.The effect and safety in the two groups were observed.Results The therapeutic effective rate was 96.0% in the observation group and 76.0% in the control group，with a statistical difference between the two groups （P＜0.05）.In comparison with the cough，chest pain，lung rale，and time of X-ray absorption in the lung，those in the observation group were much shorter than those in the control group，which were displayed statistical differences（P＜0.01）.In the observation group，2 cases were occurred with the complications，including 1 case of nasal bleeding and 1 case of postoperative fever，accounting for 4.0% in all.The complications were improved after symptomatic treatment.No complications occurred in the control group，which was not displayed a statistical difference after comparison.Conclusion Under fiber bronchoscope，bronchoalveolar lavage has a remarkable effect on severe mycoplasma pneumonia in children，which is safe and effective.[Key words]Fiber bronchoscope；Bronchoalveolar lavage；Children；Severe

Mycoplasma pneumonia

近年来，儿童支原体肺炎发病年龄呈小龄化，感染率呈直线上升，且发病隐匿、症状不典型、病程长[1]，儿童支原体肺炎可导致患儿出现肺部病变，甚至心肌炎等器质性病变[2]，严重危害患儿健康。建立人工气道，进行机械通气是抢救重症肺炎并呼吸衰竭的重要手段。但在治疗过程中往往会因气道内分泌物及痰痂的堵塞影响机械通气的效果。解除呼吸道阻塞，保持呼吸道通畅是提高儿童重症肺炎抢救成功率的关键。给予经支气管镜行支气管肺泡灌洗（bronchoalveolar lavage，BAL）能提高儿童支原体肺炎治疗成功率。本研究旨在分析纤维支气管镜在儿童重症支原体肺炎的诊断及治疗价值，现报道如下。

1资料与方法

1.1一般资料

选取我院2015年1月～2016年12月，确诊支原体肺炎患儿，并都经大环内酯类抗菌药物（阿奇霉素）正规治疗7 d及以上仍持续发热，肺部影像学表现加重患儿，且血清中C反应蛋白>40 mg/L以上的考虑为难治性支原体肺炎，行纤维支气管镜检查的支原体肺炎患儿共100例。与所有入选患儿家属签署知情同意书，入选标准：①肺部X线和CT确诊为肺炎；②实验室确诊：血清学检测支原体-IgM ≥1∶160，或急性期和恢复期双份血清特异性抗体比较，有≥4倍的增长。③用阿奇霉素（10 mg/kg·d）静脉治疗≥7 d。④本研究经医院医学伦理委员会批准，患儿及家属知情同意。100例患儿根据治疗方法不同分为两组，每组50例。对照组常规使用吸痰管吸痰、湿化治疗，观察组在对照组治疗基础上行纤维支气管镜灌洗术，两组患儿在患病性别、年龄、病程等指标比较，差异均无统计学意义（P>0.05），具有可比性（表1）。

1.2方法

1.2.1对照组常规应用呼吸机辅助呼吸、抗感染、营养支持及吸痰管吸痰、湿化对症治疗。

1.2.2观察组在抗感染、对症、机械通气基础上应用纤维支气管镜肺灌洗术，纤维支气管镜实施前4 h禁食、水。术前5～10 min用利多卡因（天津世纪药业有限公司生产，批号：H12021033）1 ml雾化，术前1 min静脉滴注咪唑安定（江苏恩华药业股份有限公司，批号：20060101）0.2～0.3 mg/kg以减少呼吸道分泌物和镇静。术前予2%利多卡因喷鼻咽黏膜3次以行表面麻醉，术中应用2%利多卡因”边麻边进”方法行气道黏膜表面麻醉[3-4]。经气管内插管导人日本OLYPUS BFXP40型纤支镜（外径2.8 mm，内径1.2 mm）及其配件在PICU内床旁操作纤术后患儿禁食禁饮2 h。

1.3观察指标

观察两组咳嗽消失时间、胸痛消失时间、啰音消失时间、X 线吸收时间及